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"It made no sense," said Robertson, 39, who lives in Centennial, Colo. "I'm in perfect health."

She was turned down because she had given birth by Caesarean section. Having the operation once increases the odds that it will be performed again, and if she became pregnant and needed another Caesarean, Golden Rule did not want to pay for it. A letter from the company explained that if she had been sterilized after the Caesarean, or if she were older than 40 and had given birth two or more years before applying, she might have qualified for coverage.

Robertson had been shopping for a better rate on individual health insurance. After being rejected by Golden Rule, she kept her existing coverage.

With individual insurance, unlike the group coverage usually sponsored by employers, insurance companies in many states are free to choose the people and conditions they cover, and base the price on a person's medical history. Sometimes, a past Caesarean means higher premiums.

Although it is not known how many women are in Robertson's situation, the number seems likely to increase because the pool of people seeking individual health insurance, now about 18 million, has been growing steadily, and so has the Caesarean rate, which is at an all-time high of 31.1 percent. In 2006, more than 1.2 million Caesareans were performed in the United States, and researchers estimate that each year, half a million women giving birth have had a Caesarean previously.

"Obstetricians are rendering large numbers of women uninsurable by overusing this surgery," said Pamela Udy, president of the International Caesarean Awareness Network, a nonprofit group whose mission is to prevent unnecessary Caesareans.

Although many women who have had a Caesarean can safely have a normal birth later, many doctors and hospitals in recent years have refused to allow such births because they carry a small risk of a potentially fatal complication, uterine rupture.

Now, Udy says, insurers are adding insult to injury. Not only are women feeling pressure to have Caesareans that they do not want and might not need, but they also might also be denied coverage for the surgery.

"You have women just caught in the middle of this huge triangle of hospitals, insurance companies and doctors pointing the finger at each other," Udy said.

Insurers' rules on prior Caesareans vary by company and also by state, because the states regulate insurers, said Susan Pisano, a spokeswoman for America's Health Insurance Plans, a trade group. Some companies ignore the surgery, she said, but others treat it as a pre-existing condition.

"Sometimes the coverage will come with a rider saying that coverage for a Caesarean delivery is excluded for a period," Pisano said. Sometimes, she said, applicants with prior Caesareans are charged higher premiums or deductibles.

Her group has reported that although 160 million Americans with health insurance have group plans through employers, the number needing individual policies probably will keep rising because of an increase in people who are self-employed or taking jobs without health benefits.

In a letter to Robertson, Golden Rule, which sells individual policies in 30 states, said it would insure a woman who had had a Caesarean only if it could exclude paying for another one for three years. But in Colorado, such exclusions are considered discriminatory and are forbidden, so Golden Rule rejects women who have had the surgery unless they have been sterilized or meet the company's age requirements.

"If you don't work for someone who has insurance, and you have to get insurance on your own, this is terrifying," Robertson said.

A spokeswoman for Golden Rule declined to say how long it had been excluding Caesareans, how it had decided to do so, or how many women were affected, saying the information is proprietary. The company, based in Indianapolis, is owned by UnitedHealthcare, which collects more than $50 billion a year in premiums and has 26 million members, most of them with group coverage.

In Colorado, people denied individual health insurance can obtain it through a state program, Cover Colorado, which insures about 7,200 people. But the premiums are 140 percent of standard rates, a spokeswoman said, adding that some women had enrolled specifically because prior Caesareans had disqualified them from private insurance.

Blue Cross Blue Shield of Florida, which has about 300,000 members with individual coverage, used to exclude repeat Caesareans, but recently began to cover them for a 25 percent increase in premiums for five years. Like Golden Rule, the company exempts women if they have been sterilized.

"After five years, if there is not a complication of pregnancy, another C-section, or if they get their tubes tied and are no longer in that risk situation, that rate-up goes away," said Randy M. Kammer, the insurer's vice president for regulatory affairs and public policy.

The higher rate is based on a Caesarean costing an average of $2,700 more than a vaginal birth (assuming no complications in either type of delivery). Kammer said Blue Cross Blue Shield cannot provide a tally of how many members are paying higher rates because of Caesareans.

"The aggravating thing is, there are a lot of elective Caesareans, and that adds to costs," she said.